Letters to the Editor
Varenicline and quitting
- John Litt
- Aust Prescr 2008;31:115-8
- 1 October 2008
- DOI: 10.18773/austprescr.2008.065
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Editor, – While Mark Ragg (Aust Prescr 2008;31:60-2) is technically correct in saying that most people quit by themselves1, he overlooks the more important point that the unaided quit rate is around 5-7%.2It is not surprising that quitting is so difficult. Nicotine addiction is a chronic relapsing condition with a relapse curve that resembles that for heroin addiction.3Popularity of strategy should not be confused with likelihood of success.
Most smokers find it very difficult to quit and are reluctant to seek help.4It is difficult to capture the true natural history of smoking cessation in a study.1 Studies that have done so show that less than 2% of smokers quit per year.5On average, smokers make between five and eight attempts before they are successful despite expressing strong interest in quitting.6
In a survey, 92% of smokers used only one strategy to quit.1The majority of published evidence recommends the use of a combination of strategies that include some form of pharmacotherapy if nicotine dependent, referral to a proactive callback program like the Quitline, enlisting support, and addressing motivation and confidence.78910 This is reflected in a reduction in the numbers needed to treat as selected strategies are combined. For example, eight smokers need to be treated with varenicline and supportive counselling to get one long-term quitter. Smokers shouldn't have to 'go it alone'. Health professionals should help them to increase their chance of success.
Department of General Practice
Department of General Practice, Flinders University Adelaide